Musings on Buddhism and modern global culture, plus a few miscellaneous topics.

Tuesday, 5 January 2010

Buddhist Mindfulness Meditation Alleviates Depression

Medicine Buddha

Meditation therapy should be routinely available on the National Health Service to treat recurring depression and to help tackle Britain’s growing mental health problems, according to a new report.

The study, commissioned by the Mental Health Foundation, found that fewer than one in 20 GPs prescribed meditation therapy for patients suffering depression, despite NHS guidance suggesting that it could halve depression relapse rates.

The report calls for much wider use of “mindfulness” treatment, which combines meditation with orthodox “thought training”. The report argues that if more GPs offered the therapy it would sharply reduce the financial burden of depression, which costs Britain £7.5 billion a year.

Mindfulness brings peace

Replacing reliance on antidepressants
Mental health specialists said that greater use of meditation would reduce an over-reliance on antidepressants. They said that while the drugs were effective, they did not help address the possibility of future depressive episodes.

Mindfulness-based Cognitive Therapy (MBCT), which has its roots in Eastern philosophy and Buddhism, trains people to focus attention on one place instead of allowing the mind to be “hijacked” by emotional issues, regrets, worries about the past and future, and other distractions. This can be done in a number of ways, for example by focusing on breathing, parts of the body, or movement.

The National Institute for Health and Clinical Excellence issued guidance on meditation in 2004 after studies suggested that it might bring benefits.

Five years later, only a fifth of GPs said they can access the treatment for their patients, and just one in 20 regularly prescribes the therapy, according to the Mental Health Foundation report Be Mindful.

MBCT costs on average £300 per patient for a course of two-hour sessions over eight weeks. Since patients are treated in groups of up to 20, the cost is said to be much lower than one-to-one cognitive behaviour therapy (CBT).

A key difference between the new approach and traditional CBT is that patients are seen between episodes of depression, and not when they are in the grip of the illness. Another difference is the inclusion of meditation, as research has shown that relying on CBT alone to prevent recurrent depression does not work as well.

Abandon self-destructive guilt

Switching off brooding recrimination
Mark Williams, Professor of Clinical Psychology at the University of Oxford, who contributed to the report, said that meditative therapy enabled people to switch off “brooding recrimination” and, while acknowledging these thoughts, move beyond them.

“People begin to see thoughts and feelings as a temporary weather pattern in the mind, and realise they don’t have to judge themselves,” he said.

More than 100 studies, some involving Buddhist monks, have shown that brainwave activity changes during meditation, and that areas of the brain linked to controlling emotion are bigger in people who have meditated regularly for five years.

Mindfulness training has also been shown to increase activity in the pre-frontal cortex, a part of the brain associated with positive emotion that is normally subdued in depressed individuals.

One in 10 people in Britain is affected by clinical depression — defined by a range of symptoms within a single two-week period — and 50 per cent of sufferers experience it more than once. After two bouts of depression, there is a 70 per cent risk of relapse, which rises to 90 per cent after three episodes.

Andrew McCulloch, chief executive of the Mental Health Foundation, said that doctors prescribed antidepressants too often. “Mindfulness-based therapy could help prevent thousands of people from relapsing into depression every year. This would have huge knock-on benefits both socially and economically, making it a sensible treatment to make available, even at a time when money is short within the NHS,” he said.

At least as effective as antidepressants

Preventing relapses
“Depression tends to come back for many people, with the odds of further bouts increasing each time. A single episode is serious enough, but having the illness return year after year can have a devastating impact on people’s jobs, relationships, and their chances in life generally.”

The case for making MBCT available on the NHS relies on two key studies of patients with recurring depression. One, undertaken ten years ago, showed a 37 per cent relapse rate for patients given MBCT, compared with 66 per cent for those not given the treatment. The other, conducted in 2004, showed an even bigger difference between the two groups, with relapse rates of 36 per cent and 78 per cent. Another recent trial in Exeter, with results published last year, indicated that MBCT is at least as effective at preventing relapses as antidepressants.

JontyHeaversedge, a South London GP who learnt to meditate at a Buddhist centre and believes the practice can improve many aspects of health, said: “Depression is something that affects a huge number of my patients, often year after year, with devastating consequences. MBCT gives them the opportunity to develop a healthier, more accepting relationship with their thoughts and feelings.”

"2010 could be the year that mindfulness meditation goes mainstream in the UK. It's already endorsed as a treatment for depression by the National Institute for Clinical Excellence, and today a major mental health charity is calling for meditation-based courses to be offered much more widely on the NHS.

A report I wrote for the Mental Health Foundation highlights the impressive clinical evidence for an approach called mindfulness-based cognitive therapy (MBCT) – the eight-week courses have been shown to reduce relapse rates by half among people who have suffered several episodes of depression. The report also finds that very few patients who could benefit from mindfulness training are currently being referred for the treatment – just one in 20 GPs prescribes MBCT regularly, despite the fact that nearly three-quarters of doctors think it would be helpful for their patients with mental health problems. Changing that could make a massive difference not only to them, but to the economy – the cost of depression to the UK has been estimated at £7.5 billion every year.

Despite its convoluted name, mindfulness-based cognitive therapy is pretty straightforward – a set of classes that teach meditation practices which help people pay attention to their breathing, body sensations, thoughts and feelings in a kind, accepting, non-judgemental way. Mindfulness training shows us how to notice and work with our experience rather than engaging in a futile struggle to fight or run away from it. That may sound simple – perhaps because it is – but developing this mindful way of relating seems to alleviate some of the suffering that struggling with life's pain creates.

Mindfulness is especially relevant to depression, in which sufferers tend to get caught up with cycles of 'rumination' - when people get depressed they churn negative thoughts over and over in their minds, a pattern which actually perpetuates their low mood. Mindfulness short-circuits rumination – by learning how to pay attention to our present moment experience, rather than getting tied up in negative thinking about the past or future, we create more space in our minds from which new, more effective decision-making can emerge. It isn't a miracle cure – while simple, the techniques take time and effort to master, but mindfulness-based therapies are now supported by a substantial and rapidly-growing evidence base that suggest they can help people cope better not just with depression, but also with the stress of conditions ranging from chronic pain and anxiety to cancer and HIV.

Mindfulness-based therapies are fundamentally and unapologetically inspired by Buddhist principles and tools – the Buddha both noted that suffering (as opposed to pain) is created by struggling with experience and prescribed mindfulness meditation as a way of working with it skilfully. However, the B-word rarely, if ever, gets a mention on MBCT courses – their reputation in health services has been built on scientific evidence rather than spiritual conviction. This is the only way it could be – while some of us Buddhists might argue that practising mindfulness can open up insights about the nature of mind that go way beyond what can be measured in a randomised-controlled trial, the most important thing here is that techniques which reduce suffering are presented in whatever way will make them most accessible to the largest number of people.

By secularising mindfulness training, and packaging it in a form that makes it amenable to clinical testing, an approach that might otherwise have been seen in medical circles as new-age flim-flam is being taken very seriously. So seriously that according to an ICM survey of GPs conducted for the Mental Health Foundation report, 64% of doctors would like to receive training in mindfulness themselves.

For that we can partly thank MorinagaSoko-Roshi, a zen teacher of Jon Kabat-Zinn, the doctor who first brought mindfulness training into US healthcare services in the 1970s. Kabat-Zinn knew that it would be considered unacceptably 'religious' to offer Buddhist training to his patients - however, he also had a strong hunch that the meditation techniques said to lead to insight on the Buddhist path might also help people cope with chronic illness. Unsure of what to do, he went to see Soko-Roshi and asked his advice. "Throw out Buddha! Throw out Zen!" came the abrupt reply.

From that, Kabat-Zinn's secular mindfulness-based stress-reduction course, a progenitor of MBCT, was born. MBSR is now taught in hundreds, perhaps thousands of institutions across the US – not just hospitals and medical settings, but schools, community centres, prisons and workplaces.

We are some way behind in the UK. Although there are now mindfulness centres at universities such as Oxford, Exeter and Bangor (the Scottish government also deserves great credit for investing strongly in mindfulness training for health professionals) most NHS trusts lack the infrastructure and personnel to offer MBCT courses to patients who could benefit from it. Even though the scientific evidence is persuasive, and GPs are on board, there simply aren't the courses for people to access.

But with the embracing of mindfulness by a growing range of powerful institutions, whose support is based on hard-nosed evidence rather than any particular commitment to Buddhism, that may now be about to change."

5 comments:

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It's likely to be more helpful for anyone who can relate to cognitive behaviour therapy's ideas, its problem-solving approach and the need for practical self-assignments. People tend to prefer this if they want a more practical treatment, where gaining insight isn't the main aim.

There is no empirical evidence supporting any long term effectiveness of CBT. If that were so, may therapists would be out of business. In addition, moderate to severely depressed people CANNOT practice CBT by virtue of their depressive condition. The causes of depression are, of course, enlightenment and actually seeing the suffering in this world and knowing only systemic changes can bring an end to it.